Brace for a Bumpy Road Ahead, Obamacare Rollout Expected to Be Patchy

The transition to Obamacare is expected to be smooth in some states and messy in others.

As part of the implementation of the Affordable Care Act, digital exchanges where individuals and businesses can shop for, compare and purchase health insurance will launch in October. Small-business owners will have their own online marketplaces to compare insurance programs and enroll in coverage for themselves and their employees, called SHOPs, an acronym for Small Business Health Options Program.

On a conference call with reporters today, organized by small-business software provider Sage, several health-care industry experts weighed in on what to expect in this first phase of Obamacare.

“My expectation is that the rollout, which starts on October 1, is going to come close to succeeding in a number of jurisdictions, and it is going to be a big mess in some others,” says Henry Aaron, health-care expert, economist and fellow at the nonpartisan Washington, D.C.-based Brookings Institution.

The transition will be very different in, say, Massachusetts than it will be in Texas, says Aaron. “The bottom line here is this experience is going to be all over the map,” he says. In Massachusetts, Maryland and Washington, D.C., Aaron has seen a “cooperative spirit” among policy makers, industry leaders and state officials, where all parties have an understanding of the inherent frustrations involved in launching a new system. “You are going to have other situations where the problems are worse because of the lack of cooperation to begin with, and people are going to point to those problems and say, ‘See? We told you so.’ ”

Small-business owners have reported feeling anxiety ahead of the implementation of the Affordable Care Act. Aaron, who has been appointed to the District of Columbia Health Benefit Exchange Authority and is responsible for establishing the health-care exchange for Washington, D.C., says he has observed “a sense of hope mixed in equal parts with deep concern and worry about what is going to happen in six months to a year.”

Seventeen states and Washington, D.C., have opted to set up their own health-care exchanges, while the rest have deferred the responsibility, leaving it in the hands of the U.S. Department of Health and Human Services. The relative level of ease that business owners can expect in signing up for the exchanges will depend on several factors, including the number of uninsured individuals in your state and cooperation from state-level regulators and insurance officials, says Aaron.

Part of the struggle is that millions of individuals will be accessing the exchanges, so even a small percentage of error can translate into a huge number of mistakes. “If we do something reasonably well, most of the time, that means we are good 90 percent of the time, which most people would give you an ‘A,’” says Bernard DiFiore, president and chief executive of BenefitMall, a benefit provider that has been involved in the implementation of exchanges in a number of states. But when you are dealing with health insurance, a 90 percent success rate is going to come across as a failure to the public.

For example, a 90 percent success rate for a health exchange that is responsible for matching 30,000 individuals would mean 3,000 very unhappy individuals, says DiFiore. A few unhappy, vocal customers have the potential to upset the public and sour them on the process entirely. That could “create massive concern about the delivery of the products, and I worry about that,” DiFiore says.

Johnny Laurent, the vice president and general manager of Sage, says Obamacare is the most pressing issue for approximately two-thirds of Sage’s clients. And politicians know that. The relative success or failure of the Affordable Care Act’s implementation is expected to be the central, deciding factor in midterm Congressional elections, says Aaron.

Media outlets and politicians will likely present a range of narratives about the implementation based on their political leanings, breeding confusion and stoking anxiety, says Aaron. "We are going to have something of a media circus starting in a couple of months," he says.

To help small-business owners navigate the process in their state, Sage is developing a computer program, expected to be released this fall, to walk employers through upcoming decisions that they will have to make. Already, a number of online resources are available to help business owners understand the upcoming decisions. See our related story: Obamacare Answers A Few Clicks Away.

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